Students question the impact of “two doors, one service”

On Monday, October 24, the Students’ Society of McGill University (SSMU) Mental Health Committee hosted a panel discussion on the state of mental health services at McGill. Panelists included Giuseppe Alfonsi, Associate Director of McGill Counselling and Mental Health Services, George Radiotis, a psychotherapist working for McGill Counselling and Mental Health Service, Teri Phillips, Director of the Office for Students with Disabilities (OSD), Chris Buddle, Dean of Students, and Quinn Ashkenazy, chair of the Peer Support Centre.

Stepped care model

The discussion began with an overview of recent changes to the structure of the McGill Counselling and Mental Health Services, including the implementation of a stepped care model. The new model is based on the system currently in place at Memorial University in St. John’s, Newfoundland. According to Alfonsi, this model will give students more power in determining their treatment plan.

The model emphasizes choice, providing a number of treatment options which serve as intermediate ‘steps’ to one-on-one psychotherapy – the treatment students typically received under the old system. The changes come in response to the strain put on the counselling and mental health services in recent years, as demand exceeds the availability of psychotherapy treatment.

According to Alfonsi, the McGill Health Clinic has seen “a 30 per cent increase in users over the last five years.”

He added that introducing a “wider menu of options of different modalities” such as group therapy, online therapy, and referrals to other organizations such as the Peer Support Centre will reduce the strain on the service.

The stepped care model also aims to avoid “handoffs,” referrals from one professional to another or from one service to another that made it difficult for the student to access appropriate services, which were common under the old system.

“Two doors, one service”

The model operates as “two doors, one service,” meaning that you can enter through either counselling or mental health, but that both are processed by a single, combined system.

One attendee raised concerns regarding the the implementation of “two doors, one service.”

“In terms of your two different teams have they become one team?” she asked. “Is there now one culture and one training and hiring process, or are they going to maintain two different kinds of philosophies, and therefore this affects the practices and the services, and therefore maybe students still should make a choice about which door to enter?”

“In terms of one culture, we just started this process, so let’s be realistic.” Alfonsi responded. “I think it’s a long-term goal to have at least one culture […] to have more communication, certainly to have common needs – which may seem like a small thing, but we didn’t have that in the past.”
He added that mental health and counselling staff will have more training and workshops together.

Phillips added that “when there is need, students can be transferred between professionals, and I would see that being the value of having a spectrum of [diverse professionals in the service].”

The stepped care model also aims to avoid “handoffs,” referrals from one professional to another or from one service to another that made it difficult for the student to access appropriate services.

Ashkenazy also said the new model expands students’ treatment options, opening the door to services such as the Peer Support Center, where students can receive help from their peers.

“Treating professionals”

The panelists also discussed the introduction of “treating professionals.” A “treating professional” is the first person a student meets with at the McGill Counselling and Mental Health Services. The “treating professional” meets with the student to determine together what their needs are and what service best suits them.

The panelists were asked whether students could expect any basic services from these “treating professionals.”

“In terms of the [treating professional], what is this person actually doing and how much time has been carved out for the professionals to deal with that?” one student asked.

“It’s more of a collaborative conversation with the student […] to determine ‘okay, these are the things that are going on right now, which ones do you want to focus on right now?’” Radiotis explained. “The treating professional […] becomes the point person for that student moving forward.”
“Is there a specific thing you can expect though from your [training professional]?” she asked.

Radiotis explained that that is determined in the first meeting between the student and professional. He emphasized once again that it is a collaborative process, based on what works best for the student.

Alfonsi suggested that the flexibility in this process is a “strength of the system” because it provides more choice for students.

Online therapy

Panelists also discussed the viability of online therapy.

Radiotis emphasized that the service is trying to incorporate online therapy into their treatment plans because it is proven to be an often effective alternative to one-on-one psychotherapy.

Alfonsi suggested that there are virtues to online therapy that don’t apply to other forms of treatment, for example, that it’s easy to access and involves little commitment from those students who don’t feel ready for psychotherapy.

International students

One attendee asked how the service is reaching out to international students. Phillips responded by expressing her own concern about a lot of international students falling through the cracks.

“The barrier actually comes from some of the cultural differences […] that disability is something that is not talked about in a lot of students’ home country or that it was very stigmatized in their home country. However, that being said, that’s where the education part is important to know about the peer services that exist,” Phillips said.

“It’s more of a collaborative conversation with the student […] to determine ‘okay, these are the things that are going on right now, which ones do you want to focus on right now?’”

— George Radiotis, Psychotherapist

Alfonsi said that McGill is working to break down barriers between international students and the Counselling and Mental Health Services, saying “that’s exactly the population we’re most concerned about.” They are also focused on expanding mental health insurance provided to international students and increasing the number of international languages in which treatment is offered.